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Diagnosis: Sister Mary Joseph's nodule



Discussion:
Sister Mary Joseph's nodule is the eponym for an umbilical metastasis from an abdominal or pelvic cancer. Sister Mary Joseph was the first assistant of surgeon William J. Mayo during the early part of the twentieth century. While prepping patients for laparotomy, she noted that those in whom she palpated an umbilical mass would predictably go on to have an internal malignancy. Her name has been indelibly linked to this phenomenon since 1949.

Sister Mary Joseph's nodule is associated with a large number of primary gastrointestinal and genitourinary cancers, including gastric, colorectal, ovarian and pancreatic adenocarcinomas. An umbilical metastasis is generally accompanied by metastases elsewhere in the abdomino-pelvic cavity, thereby portending a grim prognosis.

Our patient's CT scan revealed a 5-cm mass at the tail of the pancreas, as well as smaller nodules scattered diffusely around the abdominal cavity. Histological sections show small to large glandular/ductal structures infiltrating between collagen bundles (Fig. 3). The carcinoma is CK7 and CA19.9 positive but negative for CK20 consistent with a cholangiocarcinoma.

References:

1. Steensma DP. Sister (Mary) Joseph's nodule. Annals of Internal Medicine 2000;133:237.
2. Dubreuil A, Dompmartin A, Barjot P, Louvet S, Leroy D. Umbilical metastasis or Sister Mary Joseph's nodule. International Journal of Dermatology 1998;37:7-13.

(case taken from Washington University School of Medicine case of the month series)

Charles E. Crutchfield III, MD
Clinical Adjunct Associate Professor of Dermatology
At the
University of Minnesota Medical School
Medical Director, Crutchfield Dermatology
www.CrutchfieldDermatology.com

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